Early on use of Long-acting antipsychotics reduces hospitalization risk in schizophrenia: JAMA
New York: Long-acting injectable antipsychotics (LAIs) treatment should be considered more broadly for the treatment of early-phase schizophrenia, a recent study has revealed. According to the study, published in the journal JAMA Psychiatry, the use of LAIs in early-phase illness can significantly delay time to hospitalization. This can have implications for individual treatment decisions and public health efforts.
It was known that LAIs can potentially reduce hospitalization risk by increasing medication adherence but is rarely considered for the early-phase schizophrenia treatment. Considering this, John M. Kane, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and colleagues aimed to determine whether encouraging use of a LAI compared with usual care delays the time to first hospitalization with patients with early-phase illness.
For the purpose, the researchers set up the Prevention of Relapse in Schizophrenia (PRELAPSE) trial which was cluster randomized with a follow-up duration of 2 years. The stud period spanned from December 2014 till March 2019 and was conducted in 39 mental health centers in 19 US states. Site randomization assigned 19 clinics to encourage treatment with long-acting aripiprazole monohydrate (aripiprazole once monthly [AOM] condition) and 20 to provide treatment as usual (clinician's choice [CC] condition).
It included participants with: schizophrenia diagnosis confirmed by a structured clinical interview, fewer than 5 years of lifetime antipsychotic use, and age of 18 to 35 years. The AOM sites identified 576 potentially eligible participants, of whom 234 (40.6%) enrolled; CC sites identified 685 potentially eligible participants, of whom 255 (37.2%) enrolled.
There were no restrictions on treatment at CC sites (including using LAIs) or at AOM sites with the exception that aripiprazole monohydrate had to be prescribed within US Food and Drug Administration–approved guidelines.
The primary outcome was time to first psychiatric hospitalization based on participant interviews every 2 months, the service use resource form administered every 4 months, and other sources (eg, health records) as available.
Key findings of the study include:
- The 489 participants (368 men [75.3%]) had a mean (SD) age of 25.2 (4.2) years and 225 (46.0%) had 1 year or less lifetime antipsychotic use.
- Fifty-two AOM (22%) and 91 CC participants (36%) had at least 1 hospitalization.
- The mean survival time until first hospitalization was 613.7 days for AOM participants and 530.6 days for CC participants.
- For time to first hospitalization, the hazard ratio was 0.56, favoring AOM.
- Survival probabilities were 0.73 for AOM participants and 0.58 for CC participants.
- The number needed to treat to prevent 1 additional hospitalization was 7 participants treated with AOM compared with CC.
"Long-acting injectable antipsychotic use by patients with early-phase schizophrenia can significantly delay time to hospitalization, a personally and economically important outcome. Clinicians should more broadly consider LAI treatment for patients with early-phase illness," concluded the authors.
"Effect of Long-Acting Injectable Antipsychotics vs Usual Care on Time to First Hospitalization in Early-Phase Schizophrenia: A Randomized Clinical Trial," is published in the journal JAMA Psychiatry.
DOI: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2768027
